Shared Savings Model Risk in the MSSP Program

The Centers for Medicare and Medicaid Services (CMS) introduced the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs) as part of the Affordable Care Act. Participating ACOs accept risk for the financial outcomes of their assigned populations and share in gains (and, depending on the ACO model, losses) when these are generated. Payers and providers who negotiate value-based contracts need to be aware of and account for model risk in their contracts, particularly as the sizes of populations under management become smaller.

Health Care Sharing Ministries

What are these cost-sharing products in the individual health care market?

Payment Accuracy in Value-Based Care Contracts

Reimbursement for health care services is transferring more risk away from payers and toward health care providers in the form of Alternative Payment Models (APMs), also known as Value-Based Care (VBC) models. VBC models cover a wide variety of forms but all include guarantees by providers of services to improve quality of care and/or reduce cost.

The U.S. Health Care Debate

A health care roundtable explores the complexity of the system

The Management of Cardiometabolic Syndrome

Newtopia case study shows weight loss is a key factor

Modeling the Cost Effectiveness of VCTE for FLD

Modeling the Cost Effectiveness of VCTE for Fatty Liver Disease (FLD) In a General Population Incorporating Device Costs

Collaboration Over Competition

Similar skill sets can lead actuaries and data scientists to more shared learning opportunities

Quantum Computing—The Next Technological Transformation

We're on the brink of entering into an era of rapid and dramatic change in computing technology

Potential Abuses Within U.S. Pharmaceutical Patent Regulation

Potential Abuses Within U.S. Pharmaceutical Patent Regulation

Pharmaceutical Patent Regulation in the United States

Overview of patent system in the US, with application to pharmaceutical industry

Comparing Model Error Between a Standard Risk Adjustment Model and a Disease-Specific Risk Adjustment Model

Disease-specific health care interventions and programs are often evaluated with standard risk adjustment models or using more simplistic differences-in-differences approaches that are not customized for the target population. Using models specifically constructed for a target health condition population reduces the magnitude of the model error.

Behavioral Economics: Overview and Health Care Applications

This article provides an overview of behavioral economics

Strategies to Help Manage the Impact of COVID-19 on Elective Surgeries

Using data to help health plans and employers plan ahead, control costs and improve quality

Social Determinants of Health

Contingencies Magazine, May/June 2020

Understanding the impact of five major determinants of health (genetics, biology, behavior, psychology, society/environment) on type 2 diabetes in U.S. Hispanic/Latino families: Mil Familias - a cohort study

A study to determine the influence of the 5 major determinants of human health (genetics, biology, behavior, psychology, society/environment) on the burden of T2D for Latino families

Effects of a Population Health Community-Based Palliative Care Program on Cost and Utilization

An evaluation of utilization and cost outcomes for a community-based palliative care program provided by nurses and social workers.

Impact of Cost on the Safety of Cancer Pharmaceuticals

A chapter, Impact of cost on the safety of cancer pharmaceuticals, by Fitzner and Oteng Mensah in a recent book, Cancer Policy: Pharmaceutical Safety, aims to inform readers about the economics associated with the interplay between safety, costs of cancer treatment, and outcomes of cancer care.

Racial and Ethnic Disparities in the Burden and Cost of Diabetes for US Medicare Beneficiaries

An examination of the burden and cost of diabetes among fee-for-service Medicare beneficiaries

Disparities in Health: Why equitable care may lead to lower cost

The Actuary Magazine, August/September 2018

Public Health: Actuaries Weighing in on Healthy People 2030

Healthy People 2030’s vision is a society in which all people achieve their full potential for health and well-being across the life span. The framework outlines foundational principles, a plan of action and goals that are admirable.

Integrating Claims-Based and Survey-Based Data to Estimate Program Savings

An innovative approach to evaluating overlapping medical intervention programs

Public Health: The New Frontier

The overarching objective of the task force is twofold: first, to educate actuaries on the importance of public health and how it can inform and affect our work as actuaries—we call this the “inward” focus; and second, to open channels to enable actuaries to contribute to public health efforts—we call this the “outward” focus.

Medicaid Managed Care Organizations: Considerations in Calculating Margin in Rate Setting

Safety of Cancer Therapies: At What Cost?